Treat Schizophrenia Schizoaffective disorder Bipolar disorder Psychotic depression Off-label uses Insomnia Tics Delirium Stuttering
|
|
- Justin Thornton
- 5 years ago
- Views:
Transcription
1 Robert M. Millay RN MSN Ed Professor, Napa Valley College Psychiatric Technician Programs Copyright 2015, 2011, 2007, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Treat Schizophrenia Schizoaffective disorder Bipolar disorder Psychotic depression Off-label uses Insomnia Tics Delirium Stuttering Discovered accidentally around 1950 Chlorpromazine (Thorazine) Historically have been referred to as 1
2 Traditional antipsychotics or first generation Atypical antipsychotics or second generation High-potency drugs Fluphenazine (Prolixin) Haloperidol (Haldol) Thiothixene (Navane) Trifluoperazine (Stelazine) Moderate-potency drugs Loxapine (Loxitane) Perphenazine (Trilafon) Low-potency drugs Chlorpromazine (Thorazine) Thioridazine Low-potency drugs cause more intense anticholinergic effects High-potency drugs cause more EPSE From 1990 to the present, the new drugs are called atypical antipsychotics owing to Reduced risk of EPSE Increased effectiveness in treating negative symptoms Minimal risk of Tardive Dyskinesia (TD) Reduced risk for elevated prolactin 2
3 Atypical antipsychotics (second-generation drugs) Aripiprazole Quetiapine Clozapine Risperidone Olanzapine Ziprasidone Paliperidone Novel antipsychotics (third-generation drug) Aripiprazole Positive symptoms Excessive dopamine in the mesolimbic tract Negative symptoms Too little dopamine in the mesocortical tract Increased levels of dopamine Antipsychotic drugs block dopamine. Liberation of dopamine in the mesocortical area treats negative and cognitive symptoms. 3
4 Tract 1: Nigrostriatal tract is involved in movement. Traditional antipsychotic blockade can cause EPSE. Tract 2: Tuberoinfundibular tract modulates pituitary function. Traditional antipsychotic blockade increases prolactin levels. Tract 3: Mesolimbic tract involved in emotional and sensory processes. Traditional antipsychotic blockade relieves or eliminates hallucinations and delusions. Tract 4: The mesocortical tract is involved in cognitive processes. Traditional antipsychotic blockade can intensify negative and cognitive problems. Atypical antipsychotics can block dopamine receptors in the mesolimbic area and liberate dopamine in the mesocortical area, not obstructing the function of the nigrostriatal tract or blocking receptors in the tuberoinfundibular tract. From Roberts GW, Leigh PN, Weinberger DR: Neuropsychiatric disorders, London, 1993, Wolfe Publishing. 4
5 Tranquilizing: Antipsychotic: Most effective in treating the positive symptoms Negative symptoms are less responsive to any of the antipsychotic agents. Alterations in perception: Alterations in thought: Alterations in activity: Alterations in consciousness: Alterations in personal relationships: Alterations in affect: 5
6 Absorption: variable: Lipid soluble: Patients who abruptly stop their medications experience an antipsychotic effect for some time. Highly protein-bound Metabolized by CYP-450 enzyme system Half-life: 10 to 30 hours Impaired hepatic function Cigarette smoking... Oral and parenteral forms are available. Oral administration is the preferred route. A few oral medications dissolve instantly. Parenteral drugs... Long-acting injectable forms... Beneficial for patients who are nonadherent Fluphenazine decanoate Haloperidol decanoate Risperidone microspheres Paliperidone palmitate (Invega Sustenna) 6
7 Anticholinergic Antiadrenergic Cardiac Extrapyramidal NURSING ALERT Anticholinergic effects can Increase intraocular pressure, aggravating narrowangle glaucoma Intensify prostatic hypertrophy, making urination even more difficult Trigger arrhythmias and cause death Antiadrenergic effects Orthostatic hypotension can cause falls, Occurs most often in older adults Hypotension causes a reflex tachycardia... Be sure to assess individuals... 7
8 Martha has been taking haloperidol (Haldol) 5 mg BID for many years. Her first psychotic break took place in Due to her taking the haloperidol routinely, her positive symptoms of schizophrenia have markedly reduced. Upon assessment, Martha reports some dizziness if she moves too quickly upon awakening. She has some inner jittery feelings. What side effects is Martha demonstrating? What are the nursing actions? Common path that leads to rehospitalization EPSE nonadherence relapse rehospitalization High-potency traditional antipsychotics are the most likely cause of EPSE. Atypical antipsychotics are least likely to cause EPSE. Endocrine Elevation of prolactin levels by traditional antipsychotics Metabolic syndrome or insulin resistance syndrome Reduced metabolism of glucose and resistance to insulin by insulin receptors on cells Type 2 diabetes 8
9 Metabolic syndrome: three or more of the following: Abdominal girth greater than 40 inches in men and greater than 35 inches in women Elevated triglycerides Reduced high-density lipoproteins Elevated blood pressure Elevated fasting glucose Clozapine and olanzapine most likely to cause metabolic syndrome Sexual Caused by dopamine blockade Most significant is the third phase of sexual behavior (orgasm). Gastrointestinal Weight gain Insulin resistance is an outcome and cause of excessive weight gain. Carbohydrate craving Overdose is seldom fatal Causes severe CNS depression Restlessness or agitation, convulsions... Use in pregnancy Avoid during first trimester. Can cause EPSE in some newborns Can cause glucose intolerance 9
10 Use by older adults Reduce dose. Heightened EPSE and anticholinergic effects Higher risk for Tardive Dyskinesia (TD) Do not give to older adults with dementia-related psychosis; can cause higher risk of death Interactions with other drugs CNS depressants Alcohol Antihistamines Antianxiety drugs Antidepressants Barbiturates Meperidine Morphine Cigarette smoking Important aspect of nursing care Use discretion in selecting content of educational sessions, because of patient paranoia and anxiety. Focus on symptoms that can be seen or felt. Provide a written description of drug benefits and side effects with instructions on how to cope with side effects. 10
11 Avoid hot tubs, showers, and baths to prevent hypotension and falls. Avoid abrupt withdrawal of drug; EPSE can occur. Use sunscreen to prevent sunburn. Take medication as prescribed. Report sore throat, fever, malaise, and bleeding. Dress appropriately for hot weather; drink plenty of water. Effective, higher risk for adverse effects Less expensive Low-potency traditional antipsychotics Chlorpromazine (Thorazine) First antipsychotic Anticholinergic Antiadrenergic effects Sedating Significant weight gain Thioridazine: A few patients respond better than any other drug. Cases of sudden death have been linked to this drug. Moderate-potency Loxapine Perphenazine Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study effective as any of the atypical antipsychotics, except olanzapine Loxapine inhalation power (Adasuve) recently approved to treat agitation in schizophrenia 11
12 High potency traditional antipsychotic Fluphenazine: Prolixin Decanoate longacting form can be given IM every 2 to 3 weeks Haloperidol: causes more EPSE and fewer anticholinergic side effects Used for older adults and pediatric patients Parenteral haloperidol assists with aggressive behavior Haloperidol decanoate long-acting form IM every 2 to 4 weeks Different mechanism of action than traditional drugs and a greater effect on negative symptoms Block 5-HT 2A receptors, which liberates dopamine Faster on-off the D2 receptor Can modulate the mesolimbic function without a significant effect of the nigrostriatal tract Metabolic dysregulation: metabolic syndrome Obesity Diabetes Hyperlipidemia Hypertensive It is important for nurses to monitor patients for potential metabolic syndrome and report to the prescribing clinician. 12
13 Introduced in the United States in 1990 Serious side effect: agranulocytosis Use in individuals with severe schizophrenia who have not responded to other antipsychotic drugs Causes significant anticholinergic effects: orthostasis, sedation, weight gain, and sexual dysfunction Primarily metabolized by CYP-450 1A2; smoking decreases level of clozapine Institute therapy only if WBC is above 3500/mm 3 and ANC is 2000/mm 3 or higher. Monitor WBC weekly. If counts are normal for 6 months, monitor level every 2 weeks. If counts are normal for 1 year, monitor level every 4 weeks. Discontinue drug if WBC drops below 3000/mm 3 or ANC drops below 1500/mm 3. Monitor counts daily. If no infection is present, resume drug when counts return to normal. Permanently discontinue drug if WBC drops below 2000/mm 3 or ANC drops below 1000/mm 3. Side effects: dose-related seizures and excessive salivation Myocarditis patients need to report dyspnea, fever, chest pain, palpitations, tachycardia, and other symptoms of heart failure immediately. Fatal overdose 13
14 Risperidone (Risperdal) has greater affinity for D2 receptors and similar antagonism of 5-HT 2A receptors Favorable receptor profile both positive and negative symptoms Well-tolerated drug Decreased anticholinergic side effects No agranulocytosis, tardive dyskinesia (TD), or neuroleptic malignant syndrome (NMS) Risperidone blocks alpha-1 and H1 receptors, resulting in orthostatic hypotension, sedation, appetite stimulation Higher doses of EPSE and hyperprolactinemia Side effects: insomnia, agitation, headache, anxiety, and rhinitis Long-acting IV available Paliperidone (Invega) part of risperidone family; extended release and IM forms Olanzapine (Zyprexa): blocks 5-HT 2A and D2 receptors High affinity for cholinergic, H1, and alpha-1 receptors, causing anticholinergic effects of sedation, weight gain, and orthostasis Normalizes N-methyl-D-aspartate (NMDA) receptor function in glutaminergic system, which blocks some signs and symptoms of schizophrenia 14
15 Side effects: few incidents of EPSE Weight gain Effective in treating acute mania FDA-approved for monotherapy for bipolar disorder Long-acting IM available Jack has been on olanzapine for the last 6 months. He has experienced a rapid weight gain of 75 pounds and is upset that this is occurring. What nursing assessment is indicated? What nursing interventions can assist this patient? Quetiapine (Seroquel): similar to clozapine, lower affinity for D2 receptors than for 5-HT 2A Few anticholinergic side effects Orthostatic hypotension Sedation Appetite stimulation Effective for both positive and negative symptoms 15
16 Few incidents of EPSE Does not significantly increase prolactin levels Improves cognitive function Titrate slowly over 4 to 5 days. Taken orally, intranasally, IV Provides anxiolytic and sedative effects Ziprasidone (Geodon): effective for both positive and negative symptoms Few EPSE Few anticholinergic side effects Mild antihistamine effects Side effects: nausea, dyspepsia, abdominal pain, constipation, somnolence, insomnia, coryzal symptoms (head cold) Less weight gain Linked to potential cardiac problems due to lengthening of QTc interval Low potential for drug drug interaction IM is available Absorption increased when ziprasidone is given with food Decreases anxiety and depressive symptoms 16
17 A patient is learning about her new medication, ziprasidone (Geodon). What can the nurse teach this patient that will increase absorption? A. Take the medication without any food. B. Take the medication with graham crackers. C. Take the medication with fruit juice. D. Take the medication with food. Aripiprazole (Abilify): dopamine system stabilizer, which balances the dopamine system by increasing dopamine in brain areas where there is a deficiency and decreasing dopamine where dopamine is overactive Reduces positive symptoms Patients feel better, more energy Negative symptoms subside Asenapine (Saphris): sublingual tablet, ineffective if swallowed Used for the treatment of both acute schizophrenia and bipolar disorder Low cause of EPSE; may have some cases of akathisia Effective in treatment of cognitive and negative symptoms 17
18 Iloperidone (Fanapt): related to risperidone Metabolite of risperidone Can precipitate EPSE, prolactin elevation, and hyperprolactinemia Weight gain Sedation Orthostasis Lurasidone (Latuda): absorption improved when taken with food (similar to ziprasidone) Good side effect profile Few instances of dizziness, orthostatic hypotension, cognitive problems, sedation, or weight gain reported Glutamate hypothesis Explains both positive and negative symptoms of schizophrenia Glutamate does not pass the blood-brain barrier. Requires an obligate co-agonist Ongoing research on co-agonists 18
Schizophrenia Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM
Schizophrenia Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM NURS 203 GENERAL PHARMACOLOGY DANITA NARCISO PHARM D Learning Objectives Understand the result of dopamine binding to D2 receptors
More informationWhat Team Members Other Than Prescribers Need To Know About Antipsychotics
What Team Members Other Than Prescribers Need To Know About Antipsychotics The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State
More informationObjectives. Epidemiology. Diagnosis 3/27/2013. Identify positive and negative symptoms used for diagnosis of schizophrenia
Objectives Identify positive and negative symptoms used for diagnosis of schizophrenia Mohamed Sallout, Pharm D. Pharmacist Resident St. Luke s Magic Valley Regional Medical Center List medications used
More informationAntipsychotics. Something Old, Something New, Something Used to Treat the Blues
Antipsychotics Something Old, Something New, Something Used to Treat the Blues Objectives To provide an overview of the key differences between first and second generation agents To an overview the newer
More informationAntipsychotic Medication
Antipsychotic Medication Mary Knutson, RN 3-7-12 Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Clinical Uses of Antipsychotics Short-term: in severe depression and
More informationObjectives. Antipsychotics 7/25/2016. LeadingAge Florida 53rd Annual Convention & Exposition
Reducing the Use of Antipsychotics in Long Term Care Communities Alan W. Obringer RPh, CPh, CGP Executive Director Senior Care Pharmacy Objectives Recognize the clinical evidence for the need to change
More informationA Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer
A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.
More informationANTIPSYCHOTICS/ NEUROLEPTICS
Pharmacological Interventions Tutorial Antipsychotic medications First Generation (Typicals) Includes phenothiazines, thioxanthenes, butyrophenones ANTIPSYCHOTICS/ NEUROLEPTICS Second Generation (Atypicals)
More informationSlide 1. Slide 2. Slide 3. About this module. About this module. Antipsychotics: The Essentials Module 5 A Primer on Selected Antipsychotics
Slide 1 Antipsychotics: The Essentials Module 5 A Primer on Selected Antipsychotics Flavio Guzmán, MD Slide 2 About this module 13 antipsychotics will be studied 3 first generation antipsychotics 10 second
More informationAntipsychotics Prior Authorization Criteria for Louisiana Fee for Service and MCO Medicaid Recipients
Antipsychotics Prior Authorization Criteria for Louisiana Fee for Service and MCO Medicaid Recipients Preferred Agents (Oral) a Amitriptyline/Perphenazine (Generic) Aripiprazole Tablet (Generic) b Chlorpromazine
More informationMichael J. Bailey, M.D. OptumHealth Public Sector
Michael J. Bailey, M.D. OptumHealth Public Sector LIHP Quality Charter To ensure the quality of care delivered to enrollees in San Diego County Assistance Programs, such as County Medical Services (CMS)
More informationMedication Audit Checklist- Antipsychotics - Atypical
Medication Audit checklist Page 1 of 7 10-2018 Audit number: Client number: Ordering Provider: INDICATIONS 1) Disorders with psychotic symptoms (schizophrenia, schizoaffective disorder, manic disorders,
More informationChapter 161 Antipsychotics
Chapter 161 Antipsychotics Episode Overview Extrapyramidal syndromes are a common complication of antipsychotic medications. First line treatment is benztropine or diphenhydramine. Lorazepam is used in
More informationChapter 17. Psychoses. Classifications of Psychoses. Schizophrenia. Factors Attributed to Development of Psychoses
Chapter 17 Psychoses Drugs for Psychoses Delusions Hallucinations Illusions Paranoia Upper Saddle River, New Jersey 07458 All rights reserved. Classifications of Psychoses Acute episode Chronic episode
More informationAntipsychotics. Neuroleptics/ Major Tranquilizers. Hiwa K. Saaed, PhD Pharmacology & Toxicology /5/18 1
Antipsychotics Neuroleptics/ Major Tranquilizers Hiwa K. Saaed, PhD Pharmacology & Toxicology hiwa.saaed@univsul.edu.iq 2018-2019 12/5/18 1 Learning objectives Pharmacy students should: be familiar with
More informationHOSPITAL BASED INPATIENT PSYCHIATRIC SERVICES (HBIPS) MEASURE SET
HOSPITAL BASED INPATIENT PSYCHIATRIC SERVICES (HBIPS) MEASURE SET Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: February, 2013 Most recently revised: December 2018 The Psychiatric Measure Set CMS
More informationAntipsychotic Medications Age and Step Therapy
Market DC *- Florida Healthy Kids Antipsychotic Medications Age and Step Therapy Override(s) Approval Duration Prior Authorization 1 year Quantity Limit *Virginia Medicaid See State Specific Mandates *Indiana
More informationDosing & Administration
Dosing & Administration REAL LIFE. REAL RESULTS. INDICATION INVEGA SUSTENNA (paliperidone palmitate) is indicated for the treatment of: Schizophrenia. Schizoaffective disorder as monotherapy and as an
More informationHow did we get here? 1876 Methylene Blue. Insecticide 1935 Du Pont Anthelmintic. Garrett McCann, RPh
Polypharmacy, Adverse Effects, and the Importance of Tapering Medications for People with Intellectual and Developmental Disabilities Garrett McCann, RPh How did we get here? 1876 Methylene Blue Insecticide
More informationThe antipsychotic drugs (also called neuroleptics or major tranquilizers) are used primarily to treat schizophrenia, but they are also effective in
Antipsychotic Drugs The antipsychotic drugs (also called neuroleptics or major tranquilizers) are used primarily to treat schizophrenia, but they are also effective in other psychotic and manic states.
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Invega Sustenna, Invega Trinza) Reference Number: CP.PHAR.291 Effective Date: 12.01.16 Last Review Date: 08.18 Line of Business: Medicaid See Important Reminder at the end of this policy
More informationTHIOTHIXENE. THERAPEUTICS Brands Navane see index for additional brand names. Generic? Yes
THIOTHIXENE THERAPEUTICS Brands Navane see index for additional brand names Generic? Yes Class Conventional antipsychotic (neuroleptic, thioxanthene, dopamine 2 antagonist) Commonly Prescribed for (bold
More informationANTIPSYCHOTICS AGENTS CONVENTIONAL
ANTIPSYCHOTICS AGENTS CONVENTIONAL Documentation A. FDA approved indications 1. Psychotic Disorder (Haloperidol, Thiothixene) 2. Schizophrenia 3. Bipolar Disorder, Manic (Chlorpromazine) 4. Severe Behavioral
More informationSwitching antipsychotics: Basing practice on pharmacology & pharmacokinetics
Switching antipsychotics: Basing practice on pharmacology & pharmacokinetics John Donoghue Liverpool L imagination est plus important que le savoir Albert Einstein Switching Antipsychotics: Objectives
More informationDevon A. Sherwood, PharmD, BCPP Assistant Professor of Pharmacy Practice
Devon A. Sherwood, PharmD, BCPP Assistant Professor of Pharmacy Practice Differentiate dopamine neurotransmitter pathways associated with antipsychotic medications Identify therapy challenges associated
More informationPERPHENAZINE. THERAPEUTICS Brands Trilafon see index for additional brand names. Generic? Yes
PERPHENAZINE THERAPEUTICS Brands Trilafon see index for additional brand names Generic? Yes Class Neuroscience-based Nomenclature: dopamine receptor antagonist (D-RAn) Conventional antipsychotic (neuroleptic,
More informationPharmacotherapy of psychosis and schizophrenia in youth
Pharmacotherapy of psychosis and schizophrenia in youth Benedetto Vitiello Pavia, 2 December 2017 Disclosure Benedetto Vitiello, M.D. Professor of Child and Adolescent Neuropsychiatry University of Turin,
More informationReview of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
More informationSchizophrenia and Related Psychotic Disorders
and Related Psychotic Disorders Anand K. Pandurangi, MD Professor & Chair, Div. of Inpatient Psychiatry Director, Program VCU Medical Center 1 Kraeplin 1896 Dementia Praecox. Single, Homogenous Disorder
More informationClinical Policy: Olanzapine Long-Acting Injection (Zyprexa Relprevv) Reference Number: CP.PHAR.292 Effective Date: Last Review Date: 08.
Clinical Policy: (Zyprexa Relprevv) Reference Number: CP.PHAR.292 Effective Date: 12.01.16 Last Review Date: 08.18 Line of Business: Medicaid See Important Reminder at the end of this policy for important
More informationSP.236 / ESG.SP236 Exploring Pharmacology Spring 2009
MIT OpenCourseWare http://ocw.mit.edu SP.236 / ESG.SP236 Exploring Pharmacology Spring 2009 For information about citing these materials or our Terms of Use, visit: http://ocw.mit.edu/terms. Atypical (2
More informationWESTMEAD PRIMARY EXAM GROUP PSYCHOTROPIC MEDICATIONS
WESTMEAD PRIMARY EXAM GROUP PSYCHOTROPIC MEDICATIONS DOPAMINE HYPOTHESIS Excessive limbic dopamine is hypothesised to cause psychosis Many antipsychotics inhibit dopamine 2 receptors in mesolimbic and
More informationAbbreviated Class Review: Long-Acting Injectable Antipsychotics
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationPsychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan
Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Pretest 1. Appropriate target symptoms for emergency room medication treatment
More informationAntipsychotic Use in the Elderly
Antipsychotic Use in the Elderly Presented by: Fatima M. Ali, PharmD, RPh, BCPS Clinical Consultant Pharmacist MediSystem Pharmacy, Kingston Originally Prepared by: Nicole Tisi BScPhm, RPh ACPR Disclosure
More informationDebra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist. HMS Training Webinar January 27, 2017
Debra Brown, PharmD, FASCP Pharmaceutical Consultant II Specialist HMS Training Webinar January 27, 2017 1 Describe nationwide prevalence and types of elderly dementia + define BPSD Define psychotropic
More informationPERPHENAZINE. THERAPEUTICS Brands Trilafon see index for additional brand names. Generic? Yes
PERPHENAZINE THERAPEUTICS Brands Trilafon see index for additional brand names Generic? Yes Class Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist, antiemetic) Commonly Prescribed
More informationRiding the Waves: Tools for the Management of Bipolar Disorder
Riding the Waves: Tools for the Management of Bipolar Disorder Jacintha S. Cauffield, Pharm.D., BCPS, CDE Associate Professor of Pharmacy Practice Palm Beach Atlantic University Lloyd L. Gregory School
More informationNursing Process Focus: Patients Receiving Chlorpromazine (Thorazine)
Nursing Process Focus: Patients Receiving Chlorpromazine (Thorazine) Potential Nursing Diagnoses Ineffective Therapeutic Regimen Management Risk for Activity Intolerance, related to side effect of drug
More informationAbbreviated Class Review: Long-Acting Injectable Antipsychotics
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationTRIFLUOPERAZINE. THERAPEUTICS Brands Stelazine see index for additional brand names
TRIFLUOPERAZINE THERAPEUTICS Brands Stelazine see index for additional brand names Generic? Yes Class Neuroscience-based Nomenclature: dopamine receptor antagonist (D-RAn) Conventional antipsychotic (neuroleptic,
More informationPsychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan
Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Pretest 1. Which of the following conditions is LEAST likely to benefit from emergency
More informationFirst-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness
1 First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness This continuing education monograph examines the results of a comparative effectiveness review to compare
More informationPharmacy Benefit Management (PBM) Program FORMULARY/PRODUCT RESTRICTIONS
Workforce Safety & Insurance Revised Document Date: 07/21/2015 1600 E Century Ave Ste 1 PO Box 5585 Bismarck, ND 58506-5585 701.328.3800 1.800.777.5033 www.workforcesafety.com Pharmacy Benefit Management
More informationNEWER ATYPICAL ANTIPSYCHOTICS: NOVEL IDEAS OR
NEWER ATYPICAL ANTIPSYCHOTICS: NOVEL IDEAS OR METOOS? Sanaz Farhadian, Pharm.D., BCPP Clinical Psychiatric Pharmacist Veterans Affairs Healthcare System, San Diego, CA OBJECTIVES Discuss new antipsychotics
More informationMellaril (thioridazine)
Generic name: Thioridazine Available strengths: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg tablets; 30 mg/ml, 100 mg/ml oral concentrate Available in generic: Yes Drug class: First-generation (conventional) antipsychotic
More informationAntidepressants. Dr Malek Zihlif
Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction and the deferential diagnosis of psychiatric
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Abilify Maintena, Aristada, Aristada Initio) Reference Number: CP.PHAR.290 Effective Date: 12.01.16 Last Review Date: 08.18 Line of Business: Medicaid Coding Implications Revision Log
More informationPsychotropic Medication Use in Dementia
Psychotropic Medication Use in Dementia Marie A DeWitt, MD Diplomate of the American Board of Psychiatry and Neurology, Specialization in Psychiatry & Subspecialization in Geriatric Psychiatry Staff Physician,
More informationOut with the Old In with the New: Novel, Neuroscience-Based Re-Classification of Psychiatric Medications
Program Outline Out with the Old In with the New: Novel, Neuroscience-Based Re-Classification of Psychiatric Medications Rajiv Tandon, MD Professor of Psychiatry University of Florida College of Medicine
More informationTreat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused
Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines
More informationHave you already tried different drugs for your schizophrenia? Here s another option you and your doctor may want to consider.
Have you already tried different drugs for your schizophrenia? Here s another option you and your doctor may want to consider. 1 Benefits of Clozapine Clozapine may work when other medications don t. Doctors
More informationAPPROACH TO PSYCHOSIS IN PRIMARY CARE
APPROACH TO PSYCHOSIS IN PRIMARY CARE Family Medicine Forum 2015 Annual Meeting Toronto, Ontario November 12-14, 2015 Jon Davine, MD, CCFP, FRCP(C) Associate Professor, McMaster University Objectives
More informationPSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer
PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally
More informationREXULTI (brexpiprazole) oral tablet
REXULTI (brexpiprazole) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
More informationTalking to Patients and Their Families
Talking to Patients and Their Families About Clozapine The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health
More informationSlide 1. Slide 2. Slide 3. Risperidone Binding Profile. Risperidone Prescribing Facts. Risperidone Prescribing Facts
Slide 1 Risperidone Binding Profile (high affinity for D2 receptors) a 1 antagonist a 2 antagonist Slide 2 Risperidone Prescribing Facts 2 8 mg/day for acute psychosis and bipolar disorder 0.5-2 mg /day
More informationThis factsheet covers:
Antipsychotics If you experience psychosis as part of your illness, you may be offered antipsychotic medication. Antipsychotics are generally used to treat psychosis, but are also used to treat bipolar
More informationPsychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis
Psychiatric Illness In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis 12,000,000 children infants through 18 y/o nation wide 5,000,000 suffer severely Serious
More information10/2/2017. Evaluate existing data in regards to the appropriate treatment of schizophrenia
Evaluate existing data in regards to the appropriate treatment of schizophrenia Review risks and benefits of antipsychotic therapy in the management of acute psychosis Rebecca L. Jones, Pharm.D., B.C.P.P.
More informationAntipsychotics. This factsheet covers -
Antipsychotics If you experience psychosis as part of an illness, you may be offered antipsychotic medication. Antipsychotics are generally used to treat psychosis, but are also used to treat bipolar disorder
More informationLOXAPINE. THERAPEUTICS Brands Loxitane Adasuve (Staccato loxapine, inhaled loxapine) see index for additional brand names. Generic?
LOXAPINE THERAPEUTICS Brands Loxitane Adasuve (Staccato loxapine, inhaled loxapine) see index for additional brand names Generic? Yes Class Neuroscience-based Nomenclature: dopamine and serotonin receptor
More informationDrugs used in schizophrenia قادة فریق علم الا دویة : الشكر موصول لا عضاء الفریق المتمیزین :
MCQs SAQs Summar y Drugs used in schizophrenia قادة فریق علم الا دویة : لین التمیمي & عبدالرحمن ذكري الشكر موصول لا عضاء الفریق المتمیزین : روان سعد القحطاني فؤاد بھجت عبدالرحمن العریفي حاتم النداح pharma436@outlook.com
More informationCHLORPROMAZINE. THERAPEUTICS Brands Thorazine see index for additional brand names
CHLORPROMAZINE THERAPEUTICS Brands Thorazine see index for additional brand names Generic? Yes Class Neuroscience-based Nomenclature: dopamine and serotonin receptor antagonist (DS-RAn) Conventional antipsychotic
More informationLURASIDONE. THERAPEUTICS Brands LATUDA see index for additional brand names
LURASIDONE THERAPEUTICS Brands LATUDA see index for additional brand names Generic? No Class Neuroscience-based Nomenclature: dopamine, serotonin receptor antagonist (DS-RAn) Atypical antipsychotic (serotonin-dopamine
More informationFirst Steps: Considering Clozapine for your Patients
First Steps: Considering Clozapine for your Patients The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health
More informationAntipsychotics by Cayte Hoppner (updated by Glenice Bateman, Pharmacist, 2011)
Antipsychotics by Cayte Hoppner (updated by Glenice Bateman, Pharmacist, 2011) Introduction Antipsychotics are the foundation of pharmacological treatment of schizophrenia and other psychotic illnesses.
More informationPharmacy Medical Necessity Guidelines: Antipsychotic Medications
Pharmacy Medical Necessity Guidelines: Antipsychotic Medications Effective: July. 1, 2016 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy
More informationASHP Therapeutic Position Statement on the Use of Second-Generation Antipsychotic Medications in the Treatment of Adults with Psychotic Disorders
ASHP Therapeutic Position Statements 639 ASHP Therapeutic Position Statement on the Use of Second-Generation Antipsychotic Medications in the Treatment of Adults with Psychotic Disorders Position The American
More informationAntipsychotics Detect, Select, Effect (P.I.E.C.E.S. 6 th Ed)
Antipsychotics Detect, Select, Effect (P.I.E.C.E.S. 6 th Ed) CLeAR Webinar February 14, 2014 Paula Diaz (Pharm) Carol Ward MD Carol Ward Tertiary Mental Health IHA Hillside Centre (Acute Tertiary Mental
More informationSchedule FDA & literature based indications
Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for
More informationPharmaceutical form(s)/strength: 50, 100, 200, 400 mg tablets P-RMS:
0BCore Safety Profile Active substance: Amisulpride Pharmaceutical form(s)/strength: 50, 100, 200, 400 mg tablets P-RMS: IE/H/PSUR/0017/002 Date of FAR: 28.11.2012 Core Safety Profile [amisulpride] Formulations:
More informationPsychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA
Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA Goals of Medications Use least number at lowest dose to get
More informationAntipsychotics: The Essentials. Module 5: A Primer on Selected Antipsychotics
Antipsychotics: The Essentials Module 5: A Primer on Selected Antipsychotics Slide 1 Recently approved antipsychotics Iloperidone (Fanapt) - 2009 Asenapine (Saphris, Sycrest) - 2009 Lurasidone (Latuda)
More informationCharles P. Samenow, MD, MPH Department of Psychiatry George Washington University
Charles P. Samenow, MD, MPH Department of Psychiatry George Washington University Objectives Identify the epidemiology, symptomatology, course, causality (including genetic risk) and treatment options
More informationReview Session 3. Case. Annemarie Mikowski DO Assistant Clinical Instructor Chief Resident Psychiatry
Review Session 3 Annemarie Mikowski DO Assistant Clinical Instructor Chief Resident Psychiatry Case A 26 y/o F describes difficulty sleeping. She has been feeling steadily overwhelmed and anxious at her
More informationProviding an overview of antipsychotic drugs: is schizophrenia a psychiatric challenge?
Providing an overview of antipsychotic drugs: is schizophrenia a psychiatric challenge? Abstract Natalie Schellack, BCur, BPharm, PhD(Pharmacy), Senior Lecturer Moliehi Matlala, BPharm, MSc(Med) Pharmacy,
More informationRexulti (brexpiprazole)
Market DC Rexulti (brexpiprazole) Override(s) Approval Duration Prior Authorization 1 year Quantity Limit *Indiana see State Specific Mandates below *Maryland see State Specific Mandates below *Virginia
More informationFamily Medicine Forum November 10, 2017 Montreal. Quebec. Jon Davine, CCFP, FRCP(C) McMaster University
APPROACH TO PSYCHOSIS IN PRIMARY CARE Family Medicine Forum November 10, 2017 Montreal. Quebec. Jon Davine, CCFP, FRCP(C) McMaster University DISCLOSURE Speaker/Presenter Disclosure Not applicable Disclosure
More informationPharmacy Medical Necessity Guidelines: Antipsychotic Medications
Pharmacy Medical Necessity Guidelines: Effective: October 1, 2016 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED) Benefit
More informationDrugs 101: Behavioral Pharmacology
Drugs 101: Behavioral Pharmacology Eb Blakely, Ph.D., BCBA-D Quest, Inc./Florida Institute of Technology Drug Facts Drug effects are dose-dependent Drugs effects are time-dependent Drugs are toxic at high
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationAntipsychotics in Bipolar
Use of Second-Generation Antipsychotics in Bipolar Disorder: A Practical Guide Flavio Guzman, MD Editor Psychopharmacology Institute This practical guide is an update on the use of second-generation antipsychotics
More informationAsenapine GENERAL INFORMATION DOSING INFORMATION. Available in generic
Asenapine Generic name Available brand Available strengths and formulations Available in generic Asenapine Saphris 5-mg and 10-mg sublingual tablets No GENERAL INFORMATION Asenapine (Saphris) is an antipsychotic
More informationAbilify (aripiprazole)
Abilify (aripiprazole) FDA ALERT [04/2005] Abilify is a type of medicine called an atypical antipsychotic. FDA has found that older patients treated with atypical antipsychotics for dementia had a higher
More informationLiterature Scan: Parenteral Antipsychotics
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationPharmacy Medical Necessity Guidelines: Antipsychotic Medications
Pharmacy Medical Necessity Guidelines: Effective: April 1, 2018 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED) Benefit
More informationMeasure #383 (NQF 1879): Adherence to Antipsychotic Medications For Individuals with Schizophrenia National Quality Strategy Domain: Patient Safety
Measure #383 (NQF 1879): Adherence to Antipsychotic Medications For Individuals with Schizophrenia National Quality Strategy Domain: Patient Safety 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
More informationPsychiatric Pharmacotherapy { Objectives. Overview 4/5/2016
Psychiatric Pharmacotherapy { Elizabeth Lake, PharmD PGY1 Pharmacy Practice Resident G.V. Sonny Montgomery VA Medical Center Objectives The purpose of this activity is to enable the nurse practitioner
More informationCLOZAPINE. Clozapine, (trade name Clopine and Clozaril in Australia) is a second generation atypical antipsychotic agent.
CLOZAPINE Introduction Clozapine, (trade name Clopine and Clozaril in Australia) is a second generation atypical antipsychotic agent. Due to its potential for significant toxicity, it is reserved for patients
More informationLATUDA Commercial Update
LATUDA Commercial Update LATUDA Meeting (Tokyo) January 2011 Mark Iwicki President and Chief Operating Officer Sunovion Pharmaceuticals Inc. Sunovion Is Uniquely Positioned to Deliver Strong Performance
More informationASENAPINE. THERAPEUTICS Brands SAPHRIS see index for additional brand names
ASENAPINE THERAPEUTICS Brands SAPHRIS see index for additional brand names Generic? No Class Neuroscience-based Nomenclature: dopamine, serotonin, norepinephrine receptor antagonist (DSN-RAn) Atypical
More informationSCHIZOPHRENIA. For Primary Care Providers. Project ECHO LA Adult Psychiatry ECHO June 25, 2014
SCHIZOPHRENIA For Primary Care Providers Project ECHO LA Adult Psychiatry ECHO June 25, 2014 Curley L. Bonds, MD Medical Director Didi Hirsch Mental Health Services SCHIZOPHRENIA The most common psychotic
More information2015 Update on Psychotropics
2015 Update on Psychotropics Jeffrey T. Apter, M.D. August 2015 Princeton Medical Institute 256 Bunn Drive, Suite 6, Princeton NJ (609) 921-6050 Learning Objectives Upon completion of this session, participants
More informationSymbyax (Zyprexa [olanzapine] and Prozac [fluoxetine] combination)
Symbyax (Zyprexa [olanzapine] and Prozac [fluoxetine] combination) Generic name: Olanzapine and fluoxetine combination Available strengths: 6 mg/25 mg, 6 mg/50 mg, 12 mg/25 mg, 12 mg/50 mg (Zyprexa/Prozac)
More informationAntipsychotics. BMF 84 - Antipsychotics
Antipsychotics BMF 84 - Antipsychotics Antipsychotic medications (neuroleptics) are used for the treatment of psychosis, mainly schizophrenia and manic depression (bipolar disorder). They reduce symptoms
More informationBLONANSERIN. THERAPEUTICS Brands Lonasen see index for additional brand names
BLONANSERIN THERAPEUTICS Brands Lonasen see index for additional brand names Generic? No Class Atypical antipsychotic (serotonin dopamine antagonist; second-generation antipsychotic; also a potential mood
More informationSchizophrenia and Antipsychotic Medications
Schizophrenia and Antipsychotic Medications Model Curriculum Michael D. Jibson, M.D., Ph.D. Ira D. Glick, M.D. American Society for Clinical Psychopharmacology Pretest 1. Negative symptoms of schizophrenia
More informationAntipsychotics and stroke risk
Integrating Sentinel into Routine Regulatory Drug Review: A Snapshot of the First Year Antipsychotics and stroke risk Lockwood G. Taylor, PhD, MPH Division of Epidemiology II Office of Pharmacovigilance
More informationMedications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation
Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral
More information